How is Prescription Cost Determined with Dual Insurance?

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OpenMinded1
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Joined: Wed Feb 05, 2020 8:27 am

How is Prescription Cost Determined with Dual Insurance?

Post by OpenMinded1 »

My wife and I have dual health insurance and prescription benefits thru my former employer and thru my wife's current employer. The prescription benefit available to us thru her employer is separate from her health insurance, but she has to sign up for the health insurance to get the prescription benefit. The prescription benefit thru her employer is by MedImpact - a pharmacy benefits manager.

I know that both insurances will often pay something for medical care, medical equipment, lab work, exams etc. One insurance acts as primary insurer and the other secondary, and the claim goes thru both. However, it's my impression that pharmacies have to use one or the other of the plans when determining how much I have to pay out of pocket at the pharmacy for prescriptions. They can just pick whichever insurance results in the lowest cost to me, or they can just forgo insurance and use a coupon or something. Does this seem correct?

For those of you with dual prescription coverage what are some of your experiences with this?

Details of My Experiences in Case You are Interested.
Sometimes a pharmacy won't accept one of the two plans. CVS for example, wouldn't let me use Med Impact, so I switched pharmacies. At the pharmacy I use now, I always tell them to use Med Impact because it is usually cheaper. However, sometimes when I check claims after the fact, I see that they used the other insurance instead. Maybe that resulted in the lowest cost to me. Maybe it didn't. Sometimes I know that they aren't using the insurance that will result in the lowest out-of-pocket, so I have to bring up that I have two insurances - even though they already have that on file. For example, they said the price to me for one of my medications would be $165 for three months worth. I reminded them to use Med Impact instead of my other insurance. It ended up costing me $20. :x

On another occasion, they said the cost to me for a different med would be $165. So I mentioned to them that I had a manufacturer's coupon. (I think it was supposed to reduce the price to $30.) They said something to the effect that they didn't have any information on the coupon, even though I had used it there before, and they were supposed to have the coupon info on file. After they conferred among themselves for awhile, they said I was eligible for their pharmacy program, and therefore I didn't have to pay anything. This stuff is mind boggling.
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